Ashish V. Shah

home

authors

ashish-v-shah

Medicare Advantage (MA) is on track to become a major payer for nonmedical home-based benefits. As care continues to move into the home and community, the trend toward benefits that address social determinants of health (SDOH) will continue.

The payer industry is acknowledging what home care providers have long known: It is possible to reduce costs and improve the quality of care by offering wraparound non-medical benefits such as transportation, durable medical equipment, nutrition services and in-home support.

Since it was first signed into law over 57 years ago, Medicare has experienced significant growth and expansion, including the 1997 implementation of Part C, which granted beneficiaries a wider range of plans offered by private insurance companies.

Better known today as Medicare Advantage, Part C has grown to 28.4 million beneficiaries in 2022, accounting for 48% of the eligible Medicare population, and 55%, or $427 billion, of total federal Medicare spending, according to a recent 

The share of eligible Medicare beneficiaries enrolled in Medicare Advantage programs has more than doubled since 2007, and this year, the Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61% by 2032, according to the same report.

Regulatory changes now enable MA plans to offer members nonmedical supplemental benefits, including those that address health-related social needs and SDOH. 

For plan year 2023, such services will be offered by 1,091 Medicare Advantage plans, an increase from 729 plans in 2022 in 43 states, Washington, D.C., and Puerto Rico.

Many smaller and regional health plans seeking a competitive edge now offer broader provider networks and are turning to supplemental benefits to entice and retain members.

Testing the effect of customized benefits

State Medicaid programs have been innovating for years with long-term support services and benefits covering nutrition, home modification and in-home care support.

CMS tests a host of customized health plan benefit innovations through its MA Value-Based Insurance Design (VBID) Model. The VBID Model, which began in January 2017 and runs through December 2024, is designed to test whether allowing flexibilities in coverage and payment for Medicare Advantage organizations to promote Medicare Advantage health plan innovations would reduce Medicare expenditures, enhance quality of care and improve the coordination and efficiency of care delivery.

 that more than 1,200 MA plans will participate in VBID. Those plans will be a test of the effects of customized benefits designed to better manage chronic conditions and meet a wide range of SDOH, ranging from food insecurity to social isolation.

In-home services aimed at improving aging in place

The most exciting thing about this growth and momentum is that more plans will use supplemental benefit programs to innovate and try new approaches that can move the needle on member wellness.

But activating, coordinating, and measuring the impact of these new services is a challenge. Traditional care coordination is hampered by time-consuming tasks — phone calls, faxes, multiple emails —  to identify, activate, and coordinate services. Meanwhile, healthcare providers continue to be plagued by worsening staffing shortages, which only compound the issue.

Operationalizing VBID and supplemental benefits for members

As a result, health plans are beginning to embrace digital solutions to enable innovative care coordination for their members. When done right, processes are streamlined, care gaps are reduced, and people are happier with the experience. 

Here are six steps to start a digital transformation:

 You may want to consider differentiating yourself with new, meaningful types of home-centered services.

Digitally activate your partners in a shared online experience so you have real-time visibility into capacity and availability. This can reduce the time required to align resources to serve members in a timely 

People involved in coordinating services need to have resources necessary to keep provider information current and organized so they have up-to-date information at their fingertips and can quickly connect people with the right resources at the right time.

Service coordinators and in-home service partners should easy to engage, collaborate and create a great experience for members. This can include jointly setting performance goals around member care, encouraging partners to validate outcomes with data, and using shared technology to facilitate communication. Be clear about what information is most important and make it easy for your partners to supply it via automation or simple workflow tools.

Leverage data to determine if partners are meeting commitments on member satisfaction and service delivery. This not only helps with managing the partner network but is essential to improving member experience and supporting VBID requirements.

Members should know about available benefits and stay connected to determine satisfaction with services.

Improving connectivity is often easier said than done. As more in-home care benefits are offered, the importance of making sure those services are easily accessible will become a measure of quality — and Star ratings. When done right, investing in the technology to manage and coordinate supplemental services can lead to more healthy days at home, higher member satisfaction and, ultimately, higher rates of retention.

Articles

Payers face the logistical challenge of coordinating a network of new, non-medical services to ensure members are referred to the right provider at the right time.

  As Home-Based Supplemental Benefits Explode, Health Plans Embrace Digital Tools to Improve Access to Services

First came the rise of telehealth. Now home-based care is gaining traction with health systems and accountable care organizations (ACOs) as care delivery continues to move outside of the hospital and into the home and community.

 from The Institute of Accountable Care (IAC), showing an increase in home-based care among ACOs. In fact, half of the home-based care programs developed by ACOs were formed between 2017 and 2019 , almost double the 26% formed between 2014 and 2016, according to the same study.

,  recently acquired leading home health companies to solidify their commitment tohome-based solutions that improve patient outcomes and deliver value.

Add in growing consumer demand,and you have a healthcare environment more willing than ever to modify authorization rules and health plan design to enable a shift to in-home care.

Today’s health systems and ACOs need to position themselves for success in this changing landscape. 

But where they start? Here are four strategies to help navigate the shift to home-based care.

Most health systems and ACOs perform some level of tracking, monitoring, and trending into post-acute care 

PAC) facility utilization. But one way visibility is not enough. To optimize care, you need to know not only when patients have moved to a post-acute facility, but what’s happening once they are there.

The first step is to establish a preferred network of post-acute providers and embed those partners in the care planning process. Once you develop a shared set of expectations, care teams can work together to recognize and addresschanges in patient conditions that can reduce emergency department visits and prevent hospital admissions and readmissions.

Electronic, real-time communication and coordination help facilitate proactive care planning. A bidirectional exchange of information can help providers evaluate projected length of stay and identify candidates who can safely be cared for in the home setting. Collectively, these efforts can optimize patient satisfaction and outcomes while reducing costs.

Build a preferred home-based provider network

An effective care-at-home strategy also requires building new partnerships with service providers, including durable medical equipment (DME) suppliers, transportation, meal delivery, courier services, and more. Identifying and establishing connectivity with these services can be challenging. Many home-based providers aren’t licensed or rated by CMS and aren’t owned or operated by large healthcare organizations. Cloud-based technologies can be helpful to evaluate these new types of partners, including assessing their suites of capabilities, service areas, capacity and turnaround time. Working with organizations that can engage with you in a digital manner will be critical.

Drive timely interventions with direct patient connections

Many health Systems and ACOs leverage a variety of remote patient monitoring (RPM) tools to connect directly to patients and proactively track their health status. Unfortunately, these tools are often used only to monitor people with chronic conditions who represent a small segment of the overall need.

Moreover, the data captured by these devices only tells part of the patient story. While these tools may, for example, relay a patient’s A1C reading, they don’t tell the provider if there is healthy food in the refrigerator or if they can prepare themselves a meal.

Truly effective remote engagement needs to combine vital sign data with an engaged care team and  the patients themselves to understand the conditions that may impact someone’s health.

The goal is to help people become active participants in their own care to maintain wellnes, not just when they are recovering from an illness. Participation is most successful when it is easy for the patient. For example, automated check-ins via widely accessible mobile technologies are easier to access than hospital portals that require patients to log in and initiate the interaction.

Healthcare organizations across the country are struggling with staff shortages and burnout. To effectively navigate the shift to home-based care, health systems and ACOs need to find ways to extend their reach into the home without causing staff to feel overburdened or pushed beyond capacity.

Technology is one way to make an impact. We expect to see more providers establish “care traffic control” centers to remotely monitor people at scale and use home-based insights to identify risks and inform care plans. Text-based patient check-ins, for example, are one way to receive feedback in real time and manage by exception to help people stay home safely.

During the height of the Covid-19 pandemic, one of our clients, Jefferson Health in Philadelphia, found that 75% of its Covid-19-positive patients responded to automated, text-based check-ins and remained engaged throughout their recovery at home. Only 3% to 7% of respondents required escalation, and they were evaluated by a care coordinator to determine next steps. This approach allowed care teams to focus their attention on those patients who needed their support the most and intervene if conditions escalated.

By leveraging technology to enhance connectivity and visibility, providers can make care adjustments midstream,  incorporating home-based care where appropriate, and ultimately ensure more successful patient outcomes.

, a Chicago-based care coordination company that focuses on remote and home-based care. 

One trend to keep an eye on is the establishment of  “care traffic control” centers to remotely monitor patients and use home-based insights to identify risks and inform care plans. 

Ashish V. Shah

Articles

As Home-Based Supplemental Benefits Explode, Health Plans Embrace Digital Tools to Improve Access to Services

Navigating the Shift to Home-Based Care: 4 Strategies for Success | Ashish V. Shah